Provider Demographics
NPI:1598894735
Name:LEVINE, GARY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20401 STATE ROAD 7
Mailing Address - Street 2:SUITE G-11
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6794
Mailing Address - Country:US
Mailing Address - Phone:561-488-5772
Mailing Address - Fax:561-488-5581
Practice Address - Street 1:20401 STATE ROAD 7
Practice Address - Street 2:SUITE G-11
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6794
Practice Address - Country:US
Practice Address - Phone:561-488-5772
Practice Address - Fax:561-488-5581
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00100961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice